Amitriptyline

Amitriptyline is a tricyclic antidepressant. In the UK it is still prescribed for low mood and depression in some people, but it is also commonly used at lower doses for nerve pain (neuropathic pain), migraine prevention, and sometimes other pain conditions when a prescriber thinks it appropriate.

Your GP or pain specialist may explain the dose, how long to try it, and what to expect — response to nerve pain can take several weeks.

It increases certain brain chemicals such as serotonin and noradrenaline, which is thought to help mood and may dampen pain signalling in some nerve-related pain conditions.

For pain, doses are often lower than typical antidepressant doses, but the same cautions around side effects and interactions still apply.

Amitriptyline is usually taken once daily, often in the evening because it can cause drowsiness. Swallow tablets with water, with or without food — follow your label.

Do not stop suddenly without medical advice; your prescriber may suggest a gradual reduction to limit withdrawal-type symptoms.

Very common effects include dry mouth, drowsiness, dizziness, constipation, and blurred vision. Many people feel sleepier at first.

Weight gain, sweating, or difficulty passing urine can occur. Speak to your GP or pharmacist if side effects are troublesome.

Seek urgent help for chest pain, a fast or irregular heartbeat, confusion, fits, thoughts of self-harm, or severe allergic reaction.

Serotonin syndrome is rare but serious if combined wrongly with other serotonergic drugs — seek urgent help for agitation, high fever, muscle stiffness, or shivering.

If you miss a dose, take it when you remember unless it is nearly bedtime or your next dose is due soon. Do not double up.

If you often miss doses, ask your pharmacist about support.

Amitriptyline may not be suitable if you have had a recent heart attack, certain heart rhythm problems, severe liver problems, or if you are in the early recovery period after a heart attack — your prescriber assesses this.

It needs caution in glaucoma, enlarged prostate, epilepsy, and bipolar disorder. Always list all medicines, including Tramadol and St John’s wort.

Important interactions include MAOIs, other antidepressants, Tramadol, linezolid, and some antiarrhythmics. Alcohol increases drowsiness.

Check before starting any new prescription or over-the-counter medicine.

Discuss use in pregnancy or breastfeeding with your GP — decisions are individual.

Your prescriber may review you after starting and when changing dose, especially if you have heart risk factors or are older.

Your GP may consider other antidepressants, gabapentinoids, or other pain medicines depending on your condition, kidney function, and what you have tried before.